Ultrasound for Early Detection of Joint Disease in Patients with Hemophilic Arthropathy

Minno, Matteo Nicola Dario Di; Pasta, Gianluigi; Airaldi, Sonia; Storino, Antonio; Cimino, Ernesto; Martinoli, Carlo

doi:10.3390/jcm6080077

Cited by 33 publications

(65 citation statements)

References 58 publications

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“…The right ankle was the most severely involved joint in this report. These findings were supported by several other studies highlighting the sensitivity and utility of HEAD-US score in the early detection of HA as compared with HJHS or physical exam alone 64 , 81 – 83 .…”

Section: A New Wave In the Evaluation Of Hemophilic Arthropathysupporting

confidence: 81%

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

Bakeer

Shapiro

2019

F1000Res

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Bleeding with resultant hemophilic arthropathy constitutes the largest cause of morbidity in patients with hemophilia. It results from repeated bleeding episodes in the joint and is characterized by synovial hypertrophy and cartilage and bony destruction. Hemophilic arthropathy assessment is a continually evolving process and is particularly challenging in children and young adults in whom joint disease may be missed or underestimated as obtaining serial “baseline” magnetic resonance imaging scans of multiple clinically asymptomatic or nearly asymptomatic joints may be unjustifiable and cost-ineffective. Musculoskeletal ultrasound—particularly, point-of-care musculoskeletal ultrasound—has emerged as a promising imaging modality for the early detection and management of hemophilic arthropathy, and for the evaluation of hemarthrosis and painful musculoskeletal episodes in patients with hemophilia. This review summarizes currently available data on the emerging role of this new imaging modality, its limitations, and gaps in knowledge. The review also raises unanswered questions, highlights the need for consolidated research efforts, and delineates future directions expected to advance this technology and optimize its use in this patient population.

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Section: A New Wave In the Evaluation Of Hemophilic Arthropathysupporting

confidence: 81%

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

Bakeer

Shapiro

2019

F1000Res

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“…US has proven to be extremely sensitive in detecting low concentrations of intra-articular blood (as low as 5%) and have shown to be helpful either in distinguishing between inflammatory (serous) effusion from hemarthrosis [ 39 ] then in defining whether acute pain episodes in hemophilia patients are related to a bleed or to arthritis-mediated conditions [ 40 ]. Although joint effusion can be considered an indicator of acute hemarthrosis, this sign is reported as a transitory fluctuating parameter and cannot express the status of a joint [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…Contradictory results are reported in the literature on the ability of US to detect intra-articular deposition of hemosiderin. Some authors described some distinctive echo textural features between hemosiderin and synovium [ 41 , 49 , 53 , 54 ] but other authors did not find any difference between the US appearance of hemosiderin-laden and hemosiderin-free synovium [ 55 , 56 , 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…In terms of clinical relevance, detection of synovial hypertrophy, regardless of its degree of detectable vasculature, represents a sign of undertreatment, possibly related to an insufficient treatment regimen or a limited patient’s compliance [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, intrasynovial hyperemia at Doppler imaging is uncommonly observed in hemophilic patients and, in the rare positive cases, only a few blood flow signals are visualized, suggesting mild hypervascularity that cannot be considered relevant enough to redirect treatment and patient management [ 69 ]. In addition, high variability in the interpretation of Doppler images, the need for high-end machines to get better performance and high interequipment variability is expected [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

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The Progression of Hemophilic Arthropathy: The Role of Biomarkers

Pasta

Annunziata

Polizzi

et al. 2020

IJMS

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Background: Hemophilia A and B are X-linked congenital bleeding disorders characterized by recurrent hemarthroses leading to specific changes in the synovium and cartilage, which finally result in the destruction of the joint: this process is called hemophilic arthropathy (HA). This review highlights the most prominent molecular biomarkers found in the literature to discuss their potential use in the clinical practice to monitor bleeding, to assess the progression of the HA and the effectiveness of treatments. Methods: A review of the literature was performed on PubMed and Embase, from 3 to 7 August 2020. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: English language, available full text and articles published in peer-reviewed journal. In addition, further articles were identified by checking the bibliography of relevant articles and searching for the studies cited in all the articles examined. Results: Eligible studies obtained at the end of the search and screen process were seventy-three (73). Conclusions: Despite the surge of interest in the clinical use of biomarkers, current literature underlines the lack of their standardization and their potential use in the clinical practice preserving the role of physical examination and imaging in early diagnosis.

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The value of ultrasonography in detecting early arthropathic changes and contribution to the clinical approach in patients of hemophilia

Tamsel

Kavaklı

Özbek

et al. 2022

J of Clinical Ultrasound

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PURPOSE\AIM Hemophilia affects the blood clotting process, is a genetic disease characterized by recurrent bleeding. The hemophilia early arthropathy detection with ultrasound (HEAD‐US) procedure and scoring method were designed for the detection of early changes in affected joints of patients. In this article, it was aimed to detect early arthropathic changes in the joints of hemophilia patients with the HEAD US scoring system and to investigate its clinical contribution. It was aimed to investigate the effectiveness of HEAD‐US scoring in showing early joint damage in subclinical hemophilia cases and its contribution to treatment. METHODS The present study included 50 hemophilia patients who were admitted to Departments of Pediatric and Adult Hematology for routine follow‐up. During routine follow‐up controls, patients were scored by physical examination and HJHS 2.1 and by ultrasonography and HEAD US. Statistical tests were used to analyze joint health status and the results of US examination in the patient group. RESULTS A total of 294 joints (elbow n = 100, knee n = 94, ankle n = 100) were evaluated by ultrasonography. The mean HJHS and HEAD‐US scores of the patients were 14.94 ± 15.18 and 15.6 ± 12.6, respectively. CONCLUSIONS HEAD‐US is accepted to be more sensitive than HJHS in detecting early signs of arthropathy. Detection of early abnormalities by ultrasonography will enable the development of individualized treatment protocols and to the prevention of arthropathy development.

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Ultrasound for Early Detection of Joint Disease in Patients with Hemophilic Arthropathy

Cited by 33 publications

References 58 publications

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

The Progression of Hemophilic Arthropathy: The Role of Biomarkers

The value of ultrasonography in detecting early arthropathic changes and contribution to the clinical approach in patients of hemophilia

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